What Kinds of Rehabilitation Does a TBI Survivor Need?

Rehabilitation is a vital part of the recovery process for a TBI survivor. Moderately to severely injured patients usually first receive treatment and care in an intensive care unit of a hospital. Once stable, the survivor can be transferred to a place for more long-term rehab. Survivors follow different paths toward recovery depending on their needs.

Options include home-based rehabilitation, hospital outpatient rehabilitation, inpatient rehabilitation centers, comprehensive day programs at rehabilitation centers, supportive living programs, independent living centers, club-house programs, school-based programs for children, and others. The TBI survivor, family, and rehabilitation team members should work together to find the best place for the survivor to recover. Mentoring from other TBI survivors can also be useful, if you can find a program that matches mentors and new survivors.

Some patients may need medication for physical and emotional problems resulting from the TBI. Great care must be taken in prescribing medications because TBI patients are more prone to side effects and may react to some drugs. It is important for the family to provide social support for the survivor by being involved in the rehabilitation program. Family members may also benefit from counseling in order to cope with the demands and stress of helping to care for a TBI survivor.

New awareness of chronic traumatic encephalopathy (CTE) has spurred more interest in long-term diagnosis and monitoring of people who have had TBIs. The connection is not totally clear, but most experts feel TBIs significantly increase the risk for CTE. There is, however, no consensus on the clinical criteria for CTE and no effective treatments.

Individualized Treatment Programs

TBI survivors should receive an individualized rehabilitation program based upon the patient’s strengths and capacities. Rehabilitation services should be modified over time to adapt to the survivor’s changing needs. Moderately to severely injured patients require rehabilitation treatment that draws on the skills of many specialists. This involves individually tailored treatment programs in the areas of physical therapy, occupational therapy (learning skills for the activities of daily living), speech/language therapy, physiatry (specialists in rehabilitation medicine), psychology/psychiatry, and social support.

The overall goal of rehabilitation after a TBI is to improve the survivor’s ability to function at home and in society. Therapists help the individual adapt to disabilities and/pr make modifications to the home to make everyday activities easier.

Experimental Treatment for Frontal Lobe Injuries

A frontal lobe is frequently involved in a traumatic brain injury (TBI). When the front of the head is struck, the frontal lobes will hit the inside of the skull. The impact can result in injury because the brain is soft (about the consistency of toothpaste). And even when the back of the head is struck, the brain may bounce off the back of the skull, ricochet forward and strike the front of the skull, injuring both the back and front of the brain.
The frontal lobes are responsible for "higher" brain functions, such as planning, decision making, and judgment (which are called “executive functions”). When the frontal lobes are injured, an individual may be indecisive or apathetic and have trouble initiating activity. The frontal lobes are also responsible for regulating, checking, and inhibiting emotions and actions. As a result, some TBI survivors with frontal lobe damage are impulsive, moody, agitated, easily irritable, explosive, or make poor decisions. These survivors are quite vulnerable to becoming substance abusers.

People with Attention Deficit and Hyperactivity Disorder (ADHD) experience symptoms similar to symptoms experienced by some TBI survivors with frontal lobe damage – difficulty focusing and concentrating, impulsiveness, and poor decision making. One form of treatment for ADHD is a class of medications that includes Ritalin. These drugs stimulate the brain. While giving a stimulant to someone who is hyperactive and impulsive might seem like pouring gasoline on a fire, it is believed that the drugs stimulate the frontal lobes and increase their ability to regulate and control impulsive and inappropriate behavior while enhancing the person’s planning and decision making.

Because some of the characteristics of ADHD are similar to the symptoms shown by some TBI survivors with frontal lobe damage, scientists have conducted studies to determine if medications used to treat ADHD can be helpful in the treatment of TBI. These studies show some evidence that Ritalin is helpful with some TBI survivors in improving concentration and reducing impulsivity.
Exciting work using hypothermia to treat brain injuries is underway. If the body can be cooled to 30 degrees Celsius (normal temperature is 37) within 4 hours of the injury, damage can be reduced. New technology being used by the military allows Army medics to reduce the body temperature more quickly than in the past. A review of this work can be found
here Hpwever. it appears that in cases where there intracranial hypertension present, adding hypothermia to conventional treatment does not appear to help much.

Exercise

Exercise can help patients recover some neurological skills and abilities, according to studies in animals. Aerobic exercise is safe in the rehabilitative phase.